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You send your 16-year-old son to see the physician because he is concerned about acne that is not improving despite the use of medicine. He is embarrassed at school and when his friends call him "zit face." Needless to say, his social life is suffering as well as his personal worth and self-esteem. The doctor wants to prescribe a medication that has been shown to be very effective for acne, especially if the other medicines have not worked. Tom, as my fictitious character is named, is overwhelmed with excitement and cannot wait to head to the pharmacy to pick up his new medication. He walks into the local drugstore and the pharmacist hands him some information about the medication and encourages Tom to read it before he takes the medication because of some potential side effects. Being 16, and very concerned and anxious about getting started on his way to clear skin and social success, Tom assures the pharmacist that he will read the information and, in fact, will show it to his parents as well. Tom returns home with a smile on his face and hope for the future! He opens wide the door and conveys the exciting news to his mother about the medication and hands her the receipt and the information about it. As she reads, her excitement turns into concern. Depression, suicide and aggressive and violent behaviors are possible side effects of the medication. In addition, bone and joint pain can be severe. Maybe this is not the best idea. Maybe Tom should live with his acne and continue the medicines that he has been using. Is this new prescription worth the risk? Side effects do happen Medications are highly regulated through the FDA and extensive testing is done prior to the approval of medicines for consumer use. However, studies, although extensive, only involve a limited number of candidates. Therefore, some side effects may not be discovered or uncovered in routine trials. "After-market side effects" are reactions that occur during post-market surveillance. They are usually rare in that millions of doses may need to be given before the side effect is discovered. The severity of the side effect may vary and determine if the medication needs to be pulled from the market. For example, the depression, violent behavior and potential for suicide with Accutane were not discovered until after the product was released and wide distribution of the drug was achieved. Although rare, the severity of these effects is great and the benefit of the medication must be considered relative to the risk of the medication. This decision is a difficult one for patient and family and can apply to any medication that you are taking. How do you weigh benefit and risk? Should I take the medication or not? Have the answers before use Knowledge is power First, it is important to have the information to make a decision. When your physician is prescribing a medication that you have never taken before, ask if there are any side effects that you should be aware of that may change your decision. In this modern technology era, information about medications can be readily available. If your physician is using a computerized patient record (electronic medical record), drug information is frequently imbedded in the system and can be printed for you. The pharmacist will automatically give you information about the medication. However, do not hesitate to ask the pharmacist about potential side effects. It is their job to know about the medications and to answer your questions. Lastly, go search for the information yourself. There are many sites on the Internet that can give you accurate pharmacological information about the medication you are taking. The Center For Drug Evaluation And Research, a division of the FDA, can supply valuable information (www.fda.gov/cder). A Google search may offer many sites, but be careful about independent consumer information that may be more anecdotal than factual. Health information sites such as Medscape (www.medscape.com) can offer valuable consumer information about the medication not only of side effects but also other characteristics of the medication. The National Library of Medicine (www.nlm.nih.gov/medlineplus/druginformation.html) supports a database of medication information that can be searched and printed. The manufacturer of the medication will offer information but bias may be present decreasing reliability of the information. Do not be afraid to call back your physician to discuss information that you may have discovered in your search. After the discussion, Tom may feel his acne is not so bad. It is in your best interest to know and to make the right decision for you and your family. Dr. Clyde Wesp is a pediatrician with Southern Orange County Pediatric Associates with offices in Lake Forest, Laguna Hills, Rancho Santa Margarita, Ladera Ranch and soon to open in San Clemente and is affiliated with Saddleback Memorial Medical Center, Mission Hospital and Children's Hospital of Orange County. He is a member of the American Academy of Pediatrics and the MemorialCare Physician Society. If you have any questions or comments for Dr. Wesp you can e-mail him at askdrwesp@netscape.net. For Letters: ocfamily.com |
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